Results of operative treatment of developmental hip dislocation

الملخص EN

Objective : The means of treatment of patients with developmental dysplasia of the hip vary greatly depending on patient’s age, the severity of the condition and the morphology of the hip joint.

The purpose of this study was to assess the results of surgical treatment of developmental dislocation of the hip.

Methods : This is a retrospective study, presents our early results of treatment of this complex problem in failed conservative treatment and in older children.

Between 1996-2005, 271 children were operated for hip dysplasia or dislocation.

Patients with teratologic dislocations or neuromuscular disorders and those who underwent pelvic osteotomy other than Salter (Pemberton, Chiari, and Shelf) and the revision cases were excluded from the study.

The study identified 182 patients (225 hips) with typical developmental hip dislocation requiring operative treatment.

Open reduction through an anterior approach was used and the hip joint evaluated intraoperatively for the need of any further surgery, either pelvic osteotomy and / or femoral osteotomy.

There were 145 females and 37 males affected, 43 patients had a bilateral condition with 80 left and 59 right hips involved.

The mean age at presentation was 13 months (2 months-9 years) and the mean age at the time of surgery was 27 months (8 months-11 years).

Results : Ninety seven (53%) patients operated for failure of conservative treatment and the rest 85(47%) of the patients presented late.

Seventy four hips had only open reduction and 19 hips had only femoral osteotomy.

Open reduction and pelvic osteotomy was performed in 102 hips, while triple procedure (open reduction, pelvic osteotomy and femoral osteotomy) was performed in 25 hips, open reduction and femoral osteotomy was performed in five hips only.

Twenty four cases subsequently required femoral osteotomy for residual dysplasia or subluxation, 15 of these were from the open reduction group only, and the other nine were from the open reduction and pelvic osteotomy group.

Graft displacement was found in four cases.

Stiffness of the hip developed in four hips, three of these developed femoral fracture at Radiology Department.

Conclusion : Every case is unique.

The type of surgery chosen depends on clear understanding of the pathology of each hip after using all means.

The combination of open reduction with pelvic and / or femoral osteotomy (when indicated) gives immediate increase in stability and promotes remodeling.